UNWISE CHOICE OF PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION IN HONG KONG WHERE STENT CHOICE IS BASED ON PATIENTS’ WILLINGNESS-TO-PAY
Author(s)
Yan BP1, Chan LL1, Chan CK1, To OT1, Wong MC1, Reid C2, Lee VW1
1The Chinese University of Hong Kong, Shatin, Hong Kong, 2Monash University, Melbourne, Australia
OBJECTIVES: Percutaneous coronary intervention (PCI) in Hong Kong is self-financed (SF) and the choice between drug-eluting (DES) and bare-metal stents (BMS) is dependent on patient’s willingness-to-pay. We aimed to evaluate the outcomes and factors associated with patient’s choice of stents METHODS: We retrospectively analyzed 2330 consecutive patients who underwent PCI between Sep 2009 and Dec 2013 at a tertiary academic institution. Baseline characteristics and 12-month outcomes including death, myocardial infarction (MI), target-vessel revascularization (TVR) and composite major adverse cardiac events (MACE) were evaluated among 2 groups of patients who chose DES (SF-DES) and BMS (SF-BMS). Independent predictors of DES use and MACE were identified using multivariate analysis. RESULTS: DES were used in 1,835 (78.8%) of SF-PCI. Patients who chose DES were less likely to have a history of stroke, MI, renal failure, heart failure and present with acute coronary syndrome and cardiogenic shock (all p<0.01). There was no significant difference in income and education level between SF-DES and SF-BMS subgroups. Number of treated lesions (Odds Ratio [OR] 1.29, 95% confidence interval [CI] 1.10-1.51) was an independent predictor of DES use. Patients with a history of MI, stroke, acute ST-elevation MI, current smoker and renal failure were more likely to choose BMS. There were significantly higher 12-month mortality (5.1% vs 2.6%), TVR (2.4% vs 0.8%), and MACE (8.5% vs 3.8%) in SFI-BMS compared to SFI-DES patients (all p<0.01). The use of DES was the only independent predictor of freedom-from-MACE at 12 month (OR 0.50, 95%CI 0.33-0.76, p<0.01). CONCLUSIONS: In a healthcare system where choice of stents is largely dependent on the patient’s willingness-to-pay instead of clinical criteria, the less expensive and effective bare-metal stents remained to be used in some high risk patients and was associated with worse outcomes.
Conference/Value in Health Info
2017-05, ISPOR 2017, Boston, MA, USA
Value in Health, Vol. 20, No. 5 (May 2017)
Code
PMD87
Topic
Health Policy & Regulatory
Topic Subcategory
Public Spending & National Health Expenditures
Disease
Cardiovascular Disorders